“Calm Down” and Other Stuff not to Say to your Anxious Child

1. “Calm Down” and Other Stuff not to Say to your Anxious Child Phil Ritchie, Ph.D., C.Psych. (the other Dr. Phil)

2. Who are These Children and Youth and why are they Making Us Anxious?

3. Infants and Toddlers • What have we gotten ourselves into? • Funny, I thought having a baby would bring us closer together… • Pressure to be perfect – and trouble accepting when children aren’t. • So many experts on their children – family, friends, strangers, healthcare workers… • China, wood, or concrete?

4. Preschoolers – So that’s what a tantrum looks like • First asserting their independence and testing parents and caregivers (“I’m in a power struggle with a 2 year old and I’m losing!”). • Parent contests re developmental milestones.

5. School age children • Please don’t turn out like mom/dad. • Parent contests continue (sometimes between mom and dad). • Sports, academics, arts, social pressures, and rehab. • Can see some early emergence of mental illness at this age (e.g., anxiety disorders).

6. The Tween Years • First start presenting their own beliefs/opinions to peers and parents; can form an opinion based on available evidence • Real fears (war, violence) replace imaginary ones

7. The Tween Years cont’d • Understand delayed gratification • Contemplate self-identity, independence, values • Parents remain the principle role models (exercise, nutrition, problem-solving, managing crises).

8. Adolescence – This could get scary • The period of life when the child kicks you off the pedestal they put you on only to step up onto it themselves. • That period that immediately follows a child’s first sleeping through the night in which they decide to stay up all night and sleep through the day.

9. Adolescence – A Series of Crises (with thanks to Dr. Tracy Vaillancourt) • Identity – increasingly self-conscious, who do they want to affiliate with, sexuality • Autonomy – move away from parental influence to that of peers • Intimacy – relationships no longer based on common activities, now focuses on meeting emotional needs

10. A Series of Crises cont’d • Sexuality – biologically driven • Risk-taking – stimulation-seeking • Egocentrism – concerned with how others perceive them • This is a peak period for the emergence of mental health issues – 1 in 5 in Ontario

11. Mental Illness 1 in 5 Canadians will experience mental illness at some point during their lives. Some estimates actually have 1 in 5 children and youth experiencing mental illness (e.g., Offord et al., 1989). 70% of mental health problems begin during childhood or adolescence.

12. Mental Illness cont’d So if mental illness affects 1 in 5, the remaining 4 in 5 will have a friend, family member, or colleague with mental illness. In other words, you, a family member, spouse, or friend will likely experience mental illness. It ain’t “us and them” – it’s all of us!

13. Stigma and Mental Illness Refers to negative attitudes (prejudice) and negative behaviour (discrimination) toward people with M.I. Includes the belief that people with M.I. are not normal or like us; they caused their own problems; they can simply get over their problems if they want to. Reflects our fear/avoiding of what we don’t understand (CAMH, 2011).

14. Stigma cont’d Only 50% of Canadians would admit to having a family member with M.I. Only 49% said they would socialize with someone who has a M.I. 27% are afraid to be around someone with M.I. Stigma keeps people with M.I. from seeking help.

15. Anxiety Disorders – A Pattern of False Alarms Anxiety is a good thing – anticipating future danger or misfortune is helpful Keeps us from diving into unknown waters or walking in a dangerous neighbourhood late at night

16. False Alarms cont’d When anxiety becomes extreme or irrational, it goes from adaptive to maladaptive Most common Mental Illness affecting 12% of population, more than half of which will develop as children or youth

17. Anxiety Disorders In general, in order to meet criteria as an anxiety disorder, the associated fear is not just a brief and passing phenomenon, and is interfering with regular development/ normal functioning, and may or may not be recognized as excessive or unreasonable

18. Anxiety Disorders cont’d Panic Disorder Specific Phobia Social Phobia (Social Anxiety Disorder) OCD (DSM 5 change) Generalized Anxiety Disorder Separation Anxiety Disorder Anxiety Disorder NOS PTSD (DSM 5 change) Selective Mutism (DSM 5 change)

19. Panic Disorder Recurrent, unexpected panic attacks With or without agoraphobia Worry about having further attacks or the implications of having an attack (e.g., losing control, heart attack, etc.) Interferes with normal functioning

20. Specific Phobia Exposure to phobic stimulus evokes an immediate anxiety response Situation is avoided or endured with intense anxiety/distress Interferes with normal functioning

21. Social Phobia (Social Anxiety Disorder) Marked fear in social situations, particularly if dealing with unfamiliar people or scrutiny by others Acutely sensitive to ridicule/humiliation/embarrassment Social situations either avoided or endured with intense anxiety/distress Interferes with normal functioning

22. OCD Obsessions – persistent thoughts, impulses, images that are intrusive and inappropriate; not just excessive worries about real life problems Compulsions – repetitive behaviours or mental acts the person feels driven to do because of obsessions or “rules” Interferes with normal functioning DSM 5 – Obsessive Compulsive and related disorders

23. Post-Traumatic Stress Disorder(DSM5 Trauma and Stressor-Related Disorders) Unique - requires a precipitating event involving actual or threatened death or serious injury, or threat to the physical integrity of self or others Response involves intense fear, helplessness, or horror Event is re-experienced

24. PTSD cont’d Avoidance of stimuli associated with the trauma and numbing of general responsiveness Increased arousal, e.g., hyper-vigilance Interferes with normal functioning Acute Stress Disorder is essentially PTSD from 2-28 days post-incident

25. Generalized Anxiety Disorder Excessive anxiety and worry the person feels unable to control May at times be focused on specific situations (e.g., grades, health) but at other times, not directed at anything in particular but still worried Interferes with normal functioning

26. Selective Mutism Consistent failure to speak in specific social situations in which there is an expectation for speaking despite being able to speak elsewhere The disturbance interferes with educational or occupational achievement or social comm’n The duration of the disturbance is > 1 month The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

27. Separation Anxiety Disorder Unique in that it is primarily in young children but can be youth as well Extreme anxiety about being separated from parents/home Developmentally inappropriate anxiety Interferes with normal functioning

28. Bullying • The effects of bullying on anxiety, depression, and suicide rates have been consistently demonstrated (e.g., Miller, 2009). • 10% of kids who bully are the stereotypical impulsive non-discriminating kid – anywhere, anytime, with anyone. • 90% are actually quite popular, sneaky, and powerful (Vaillancourt, 2003).

29. Bullying cont’d • The most popular kids are also the most abusive of their peers. • Very socially skilled (easily fool parents and teachers), have high but fragile self-esteem, and command fear rather than respect or affection from their peers. • Boys and athleticism; girls and looks.

30. Resilience in Vulnerable Children and Youth • Who is vulnerable? Those who have experienced abuse, or come from families struggling with mental illness, substance abuse, violence, or other instability. • Protective factors: caring family, connection with school, caring adults, supportive friends with + social values (McCreary Centre Society, 2006).

31. Protective Factors and Resilience • Family and school connectedness were two of the most strongly protective factors for youth who were abused or came from challenging homes. • Liking school, feeling safe at school, and having a supportive adult in the family to talk to are all protective. • Relationships with friends having pro-social values has a demonstrably + impact.

32. The Developing Brain Brain develops to mid-20s Children’s brains – its about associations At puberty, pruning process – use it or lose it Motor and sensory areas are quite sophisticated in adolescents while decision-making (important for impulse-control and emotional regulation) centres remain underdeveloped

33. The Developing Brain cont’d • When communicating with anyone in crisis, important to understand how it affects not only their thinking, but also ours (i.e., the adult brain). • Big stress response (HPA Axis) results in blood being diverted from neocortex to lower areas (limbic and reptilian brains)

34. The Developing Brain cont’d • Go into survival mode and the reptilian brain kicks in • Alligators are brilliant survivors, “living fossils” that have existed 200M years • Alligators are not so good at problem-solving

35. The Developing Brain cont’d • In survival mode, we get “alligator stupid” (with thanks to Dr. Matthew Sharps) • Reptilian brain is reliable but rigid and compulsive • “Four Fs” – feeding, fleeing, freezing, and mating

36. The Developing Brain cont’d • Survival mode is a vestige of our hunter/gatherer brain • Tunnel vision can be helpful if pursuing a wild boar looking to turn it into dinner • Not so helpful if staring at the hickey on our teenage daughter’s neck or the crack in the new HDTV after our son invited a “few friends” over c/o Facebook while we were out of town

37. The Developing Brain cont’d • Need our neo-cortex for more advanced problem-solving (don’t try to fit head in peanut butter jar – get a spoon) • Also need the neo-cortex to manage sub-cortical parts of brain, and to separate affect from problem-solving

38. The Parent Brain (with thanks to Dr. Matthew Sharps) • When it comes to being a role model, it’s important to understand not only kids’ thinking, but also our own, particularly when stressed. • Big stress response (HPA Axis) results in blood being diverted from neocortex to lower areas (limbic and reptilian brains).

39. The Adult Brain cont’d • In survival mode, the reptilian brain kicks in (we get “alligator stupid”). • Reptilian brain is reliable but rigid and compulsive. • “Four Fs” – feeding, fleeing, freezing, and mating. • Not so helpful when navigating conflict with a child/youth.

40. The Adult Brain cont’d • While dealing with a crisis, important to get out/stay out of “alligator stupid” mode, and have the higher centres (better problem-solving) of the brain remain active. • Chronic stress, a bad night’s sleep, too many skinny pumpkin spice lattés (they were on sale), or a history of early trauma can make this more challenging.

41. Coping with Anxiety:Ours and Theirs • When appropriate, taking a few slow, big breaths can help (longer breaks if necessary). • Become the surrogate neo-cortex – get the child to slow down, help her/him see that there are other solutions.

42. PARAVERBALS – It’s not what you say but how you say it • As anxiety increases, people stop processing content. • Paraverbals refer to tone, volume, and cadence. • Woman without her man is nothing. • Woman: without her, man is nothing.

43. ACTIVE LISTENING Two distinguishing characteristics: Listener grasps both the facts and feelings. Conveys that the other’s point of view is understood.

44. ACTIVE LISTENING • When dealing with someone anxious or agitated, recognizing and validating their feelings can help diffuse any anger: “you seem angry, what’s gone on?” • You can empathize/validate without agreeing with them: “I think I’d feel angry too if I thought someone had treated me like I was stupid.” • “Just calm down” is the fastest, surest way to achieve the opposite result (if not sure - ask your spouse).

45. ACTIVE LISTENING • Offer your undivided attention and sufficient time to address the concern. • Use eye contact, other non-verbal cues to convey that there is no more important way for you to spend your time at this moment. • Check the facts before countering with a rebuttal (you’ll get there) – “If I understand correctly…” • Take turns – get them to check their facts.

46. Classroom Accommodations for the Anxious Student Check in with student on arrival Don’t penalize for being late (symptoms at home often interfere with getting out the door) Assist with peer interactions Anticipate difficulty with transitions Give notice re. changes in routine

47. Classroom Accommodations cont’d Extra time for tests and assignments Safe place Use of nonverbal cues so as not to centre out the student Model appropriate coping behaviours

48. Supporting the Anxious Child Worry Answer the “what ifs” and take away anxiety associated with the unknown Track improvements with feedback to your child/youth Have them rate their fear and then track it

49. Support cont’d • Emotional Outbursts • Identify triggers with the child/youth • Encourage them to problem-solve (e.g., CPS) • Develop a hierarchy of safe places (home and school) in which to de-escalate from a meltdown

50. Support cont’d • Separation Anxiety (typically younger children with school) • Begin classroom session with something enjoyable to warm up the student • Parent can send a note congratulating student on success • Allow a 30 second phone call from student to parents (scripted and parents prompted not to respond to tears)